Sen. Mattie Hunter
Filed: 3/20/2015
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| 1 | AMENDMENT TO SENATE BILL 1792
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| 2 | AMENDMENT NO. ______. Amend Senate Bill 1792 by replacing | ||||||
| 3 | everything after the enacting clause with the following:
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| 4 | "Section 5. The Illinois Public Aid Code is amended by | ||||||
| 5 | adding Section 12-4.49 as follows: | ||||||
| 6 | (305 ILCS 5/12-4.49 new) | ||||||
| 7 | Sec. 12-4.49. Medicaid Pilot Program for Diabetes | ||||||
| 8 | Self-Management Education/Training. | ||||||
| 9 | (a) Legislative findings. It is the intent of the General | ||||||
| 10 | Assembly to ensure that the State can help reduce Medicaid | ||||||
| 11 | healthcare costs associated with the treatment of diabetes and | ||||||
| 12 | its related complications. Diabetes education is a service that | ||||||
| 13 | is underutilized and not readily available. Unlike most other | ||||||
| 14 | chronic health conditions, diabetes treatment deeply relies on | ||||||
| 15 | education to assist patients in modifying their unhealthy | ||||||
| 16 | behaviors to better self-manage their condition. An accredited | ||||||
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| 1 | Diabetes Self-Management Education (DSME) program can help. A | ||||||
| 2 | quality DSME program is one that is certified by a Nationally | ||||||
| 3 | Accredited Organization (NAO). Currently both the American | ||||||
| 4 | Association of Diabetes Educators (AADE) and the American | ||||||
| 5 | Diabetes Association (ADA) are NAOs who certify DSME programs. | ||||||
| 6 | Diabetes Educators are a part of the team that make up a | ||||||
| 7 | certified DSME program. A diabetes educator works with patients | ||||||
| 8 | to develop a plan to stay healthy and to give them the tools | ||||||
| 9 | and ongoing support to make that plan a regular part of their | ||||||
| 10 | lives. Studies have found that teaching patients how to | ||||||
| 11 | effectively control their diabetes through self-management and | ||||||
| 12 | on-going support is considered one of the most important and | ||||||
| 13 | cost-effective tools in the arsenal of diabetes treatment in | ||||||
| 14 | order to avoid the deadly and costly comorbidities associated | ||||||
| 15 | with the disease. | ||||||
| 16 | To test whether outpatient diabetes education can reduce | ||||||
| 17 | the State's healthcare costs and improve overall health, the | ||||||
| 18 | General Assembly finds that a Medicaid Pilot Program for | ||||||
| 19 | Diabetes Self-Management Education/Training (DSME/T) utilizing | ||||||
| 20 | qualified diabetes educators in a quality DSME program | ||||||
| 21 | certified by one of the NAOs is needed to achieve these goals. | ||||||
| 22 | (b) Pilot program. The Department of Healthcare and Family | ||||||
| 23 | Services shall establish a 2-year countywide Medicaid Pilot | ||||||
| 24 | Program for DSME/T that covers the following: full initial | ||||||
| 25 | individualized assessment, plan of care, education based on | ||||||
| 26 | healthy eating, being active, monitoring, medication, reducing | ||||||
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| 1 | risk, problem solving and healthy coping, measurable | ||||||
| 2 | behavioral goals, improved clinical outcome measures, ongoing | ||||||
| 3 | support, follow-up, and continuous quality improvement. | ||||||
| 4 | (c) Reimbursement formula. The reimbursement formula for | ||||||
| 5 | qualified diabetes educators shall be based on the hours of | ||||||
| 6 | treatment and shall be set up similar to the Medicare Part B | ||||||
| 7 | model. This training can be set up in groups or individual. The | ||||||
| 8 | patient shall receive an initial 10 hours of education followed | ||||||
| 9 | by 2 hours for follow-up. | ||||||
| 10 | (d) AADE. The Department of Healthcare and Family Services | ||||||
| 11 | shall develop more than one pilot program in consultation with | ||||||
| 12 | the American Association of Diabetes Educators (AADE) and with | ||||||
| 13 | any other group of qualified diabetes educators. | ||||||
| 14 | (e) Required standards. The required standards for | ||||||
| 15 | qualified diabetes educators shall be found in the National | ||||||
| 16 | Standards for Diabetes Self-Management Education and Support. | ||||||
| 17 | These standards were revised in 2012 and are evidenced based. | ||||||
| 18 | (f)
Program quality. Quality and qualified diabetes | ||||||
| 19 | educators must meet requirements of certification by one of the | ||||||
| 20 | NAOs who include the AADE or the ADA. | ||||||
| 21 | (g)
Continuing education. Continuing education shall be a | ||||||
| 22 | requirement of a certified Diabetes Self-Management Education | ||||||
| 23 | and Support Program. | ||||||
| 24 | (h) Final report. The pilot program shall operate for 2 | ||||||
| 25 | years. At the end of the 2-year period the Department shall | ||||||
| 26 | submit a final report to the General Assembly that provides a | ||||||
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| 1 | comparison analysis of the results of the various county pilot | ||||||
| 2 | programs to the healthcare results of counties of a comparable | ||||||
| 3 | size that do not provide the diabetes services offered under | ||||||
| 4 | the pilot program. The report shall also include guidance, | ||||||
| 5 | recommendations, and best practices on how to lower glucose | ||||||
| 6 | levels, treat hypoglycemia, and show a reduction in | ||||||
| 7 | re-hospitalization and emergency department admissions caused | ||||||
| 8 | by uncontrolled diabetes.
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| 9 | Section 99. Effective date. This Act takes effect January | ||||||
| 10 | 1, 2016.".
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